Impact of matrix support on older adults in primary care: randomized community trial
DOI:
https://doi.org/10.11606/s1518-8787.2021055002685Keywords:
Health of the elderly, Matrix support, Primary health care, Public health, Clinical trialAbstract
OBJECTIVE To analyze the effect of matrix support on health for older adults in primary care according to the dimensions of frailty measured with the Clinical-Functional Vulnerability Index-20 (IVCF-20). METHODS This is a randomized controlled community trial, developed in the Northern Minas Gerais state, Brazil, in 2018. Initially, the stratification of clinical and functional vulnerability of older adults supported by six Family Health Strategy teams occurred with the IVCF-20. Subsequently, three teams were drawn to receive matrix support for six months, and the others for control. In this intervention, face-to-face educational activities were developed for health teams. Descriptive statistics were performed, followed by bivariate analysis by Pearson’s chi-square test, to compare the variables of the IVCF-20 between the two moments (before and after the intervention), with a 5% significance level. Relative risks and respective 95% confidence intervals (95%CI) were estimated. RESULTS The groups were similar before intervention, and the effect of matrix actions was positive for most dimensions measured by IVCF-20 (instrumental daily living activity, cognition, mood, mobility, communication, and multiple comorbidities). At the end of the research, the percentage of frailty in the group assisted by professionals participating in matrix support was lower than that of the control group. CONCLUSIONS Matrix support actions, such as pedagogical attribution and horizontal care for health teams, have the potential to contribute to the articulation of models of care for older adults.
References
Ministério da Saúde (BR). Diretrizes para o cuidado das pessoas idosas no SUS: proposta de modelo de atenção integral à saúde da pessoa idosa: XXX Congresso Nacional de Secretarias Municipais de Saúde [Internet]. Brasília (DF): Ministério da Saúde; 2014 [cited 2020 Dec11]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_cuidado_pessoa_idosa_sus.pdf [ Links ]
World Health Organization. World report on ageing and health 2015 [Internet]. Geneva: WHO; 2015 [cited 2020 Dec11]. Available from: http://www.who.int/ageing/events/world-report-2015-launch/en/ [ Links ]
Martins AB, D’Avila OP, HilgertJB, Hugo FN. Atenção primária a saúdevoltada as necessidades dos idosos: da teoria à prática. Ciên Saúde Colet. 2014;19(8):3403-16. https://doi.org/10.1590/1413-81232014198.13312013 [ Links ]
Beard JR, Officer A, Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145-54. https://doi.org/10.1016/s0140-6736(15)00516-4 [ Links ]
Lino VTS, Portela MC, Camacho LAB, Rodrigues NCP, Andrade MKN, O’Dwyer G. Rastreamento de problemas de idosos na atenção primária e proposta de roteiro de triagem com uma abordagem multidimensional. Cad Saúde Pública. 2016;32(7):e00086715. https://doi.org/10.1590/0102-311X00086715. [ Links ]
Veras RP, Oliveira M. Envelhecer no Brasil: a construção de um modelo de cuidado. Ciên Saúde Colet. 2018;23(6):1929-36. https://doi.org/10.1590/1413-81232018236.04722018 [ Links ]
Ministério da Saúde (BR). Orientações técnicas para a implementação de linha de cuidado para atenção integral à saúde da pessoa idosa no Sistema Único de Saúde – SUS [Internet]. Brasília (DF): Ministério da Saúde; 2018 [cited 2020 Dec11]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/linha_cuidado_atencao_pessoa_idosa.pdf [ Links ]
Nunes LO, Castanheira ERL, Dias A, Zarili TFT, Sanine PR, Mendonça CS, et al. Importância do gerenciamento local para uma atenção primária à saúde nos moldes de Alma-Ata. Rev. Panam Salud Publica. 2018;42:e175. https://doi.org/10.26633/RPSP.2018.175 [ Links ]
Turner G, Clegg A. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing. 2014;43(6):744-7. https://doi.org/10.1093/ageing/afu138 [ Links ]
Harrison JK, Clegg A, Conroy SP, Young J. Managing frailty as a long-term condition. Age Ageing. 2015;44(5):732-5. https://doi.org/10.1093/ageing/afv085 [ Links ]
Inzitari M, Pérez LM, Enfedaque MB, Soto L, Díaz F, Gual N, et al. Integrated primary and geriatric care for frail older adults in the community: implementation of a complex intervention into real life. Eur J Intern Med. 2018;56:57-63. https://doi.org/10.1016/j.ejim.2018.07.022 [ Links ]
Ofori-Asenso R, Chin KL, Mazidi M, Zomer E, Ilomaki J, Zullo AR, et al. Global incidence of frailty and prefrailty among community-dwelling older adults: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(8):e198398. https://doi.org/10.1001/jamanetworkopen.2019.8398 [ Links ]
Kojima G, Liljas AEM, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk ManagHealthc Policy. 2019;12:23-30. https://doi.org/10.2147/RMHP.S168750 [ Links ]
Gwyther H, Shaw R, Dauden EAJ, D’Avanzo B, Kurpas D, Bujnowska-Fedak M, et al. Understanding frailty: a qualitative study of European healthcare policy-makers’ approaches to frailty screening and management. BMJ Open. 2018;8(1):e018653. https://doi.org/10.1136/bmjopen-2017-018653 [ Links ]
Maia LC, Moraes EN, Costa SM, Caldeira AP. Fragilidade em idosos assistidos por equipes da atenção primária. CiênSaúde Colet.2020;25(12):5041-50. https://doi.org/10.1590/1413-812320202512.04962019 [ Links ]
Maia LC, Colares TFB, Moraes EN, Costa SM, Caldeira AP. Idosos robustos na atenção primária: fatores associados ao envelhecimento bem-sucedido. RevSaúde Pública. 2020;54:35. https://doi.org/10.11606/s1518-8787.2020054001735 [ Links ]
Hirdes A. Apoio Matricial em saúde mental: a perspectiva dos especialistas sobre o processo de trabalho. SaúdeDebate. 2018;42(118):656-68. https://doi.org/10.1590/0103-1104201811809 [ Links ]
Iglesias A, Avellar LZ. Matriciamento em saúde mental: práticas e concepções trazidas por equipes de referência, matriciadores e gestores. CiênSaúde Colet. 2019;24(4):1247-54. https://doi.org/10.1590/1413-81232018244.05362017 [ Links ]
Barros JO, Gonçalves RMA, Kaltner RP, Lancman S. Matrix support strategies: the experience of two Family Health Support Centers (NASFs) in São Paulo, Brazil. Ciên Saúde Colet. 2015;20(9):2847-56. https://doi.org/10.1590/1413-81232015209.12232014 [ Links ]
Campos GWS, Domitti AC. Apoio matricial e equipe de referência: uma metodologia para gestão do trabalho interdisciplinar em saúde. Cad Saúde Pública. 2007;23(2):399-407. https://doi.org/10.1590/S0102-311X2007000200016 [ Links ]
Chiaverini DH, organizadora; GonçalvesDA, Ballester D, Tófoli LF, Chazan LF, Almeida N, Fortes S. Guia prático de matriciamento em saúde mental [Internet]. Brasília(DF): Ministério da Saúde; 2011 [cited 2020 Dec11]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/guia_pratico_matriciamento_saudemental.pdf [ Links ]
Lourenço RA, Moreira VG, Mello RGB, Santos IS, Lin SM, Pinto ALF, et al. Consenso brasileiro de fragilidade em idosos: conceitos, epidemiologia e instrumentos de avaliação. GeriatrGerontolAging. 2018;12(2):121-35. https://doi.org/10.5327/Z2447-211520181800023 [ Links ]
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-7. https://doi.org/10.1016/j.jamda.2013.03.022 [ Links ]
Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. ClinGeriatr Med. 2011;27(1):17-26. https://doi.org/10.1016/j.cger.2010.08.008 [ Links ]
Cesari M, Prince M, Thiyagarajan JA, CarvalhoIA, Bernabei R, Chan P, et al. Frailty: an emerging public health priority. J Am Med Dir Assoc. 2016;17(3):188-92. https://doi.org/10.1016/j.jamda.2015.12.016 [ Links ]
Faller JW, Pereira DN, Souza S, Nampo FK, Orlandi FDS, Matumoto S. Instruments for the detection of frailty syndrome in older adults: a systematic review. PLoS One. 2019;14(4):e0216166. https://doi.org/10.1371/journal.pone.0216166 [ Links ]
Moraes EN, Carmo JA, Moraes FL, Azevedo RS, Machado CJ, Montilla DER. Índice de Vulnerabilidade Clínico Funcional-20 (IVCF-20): reconhecimento rápido do idoso frágil. Rev SaúdePública. 2016;50:81. https://doi.org/10.1590/s1518-8787.2016050006963 [ Links ]
Kojima G, Taniguchi Y, Iliffe S, Jivraj S, Walters K. Transitions between frailty states among community-dwelling older people: a systematic review and meta-analysis. Ageing Res Rev. 2019;50:81-8. https://doi.org/10.1016/j.arr.2019.01.010 [ Links ]
Ofori-Asenso R, Chin KL, Mazidi M, Zomer E, Ilomaki J, Ademi Z, et al. Natural regression of frailty among community-dwelling older adults: a systematic review and meta-analysis. Gerontologist. 2020;60(4): e286-98. https://doi.org/10.1093/geront/gnz064 [ Links ]
Feng Z, Lugtenberg M, Franse C, Fang X, Hu S, Jin C, Raat H, et al. Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: a systematic review of longitudinal studies. PLoSOne. 2017;12(6):e0178383. https://doi.org/10.1371/journal.pone.0178383 [ Links ]
Silva SLA, Neri AL, Ferrioli E, Lourenço RA, Dias RC. Fenótipo de fragilidade: influência de cada item na determinação da fragilidade em idosos comunitários – Rede Fibra. Ciên Saúde Colet. 2016;21(11):3483-92. https://doi.org/10.1590/1413-812320152111.23292015 [ Links ]
Carneiro JA, Lima CA, Costa FM, Caldeira AP. Cuidados em saúde estão associados à piora da fragilidade em idosos comunitários. Rev Saúde Pública. 2019;53:32. https://doi.org/10.11606/s1518-8787.2019053000829 [ Links ]
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Copyright (c) 2021 Luciana Colares Maia, Thomaz de Figueiredo Braga Colares, Edgar Nunes de Morais, Simone de Melo Costa, Antônio Prates Caldeira
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Fundação de Amparo à Pesquisa do Estado de Minas Gerais
Grant numbers Processos: CDS - APQ-02965-17 e CDS-BIP00128-18 -
Conselho Nacional de Desenvolvimento Científico e Tecnológico
